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Objetivos: 1) Caracterizar cuantitativamente la indicación farmacéutica (IndF). 2) Caracterizar cualitativamente la IndF: a) caracterizar a los pacientes; b) analizar la frecuencia y los motivos de consulta más habituales, y c) analizar las recomendaciones indicadas. 3) Valorar la calidad del método de registro cualitativo. Método: Estudio descriptivo transversal. Se registraron todas las IndF, durante 3 meses, de todo usuario que solicitara una indicación para un problema de salud, ya fuera para él mismo o para otra persona, en una farmacia comunitaria. El registro cuantitativo se llevó a cabo mediante el sistema de gestión, y el cualitativo mediante una hoja ad hoc en papel, registrando datos del paciente, de la consulta y de la recomendación y en qué momento se realizó el registro, si durante la entrevista con el paciente (método Foro) o más tarde. Resultados: Se realizaron 690 indicaciones y, de ellas, el 60% pudo ser registrado cualitativamente. Casi un 60% de las IndF registradas cualitativamente fueron para mujeres en edades entre los 45 y los 60 años, y en la mayoría de los casos fue el propio paciente quien solicitó las indicaciones. El motivo de consulta más frecuente fue el dolor. Los medicamentos más aconsejados fueron los del sistema respiratorio, con un 25%. La mayoría de las IndF se resolvieron con una especialidad farmacéutica publicitaria (EFP) o un producto sanitario. Conclusiones: Se consiguió registrar cualitativamente un 60% del total de las IndF. La mayoría de las IndF demandadas se resolvieron con la recomendación de un medicamento. La gran solicitud de indicaciones para el dolor no relacionadas con la recomendación de analgésicos refleja la importancia del asesoramiento farmacéutico.

This article was migrated. The article was marked as recommended. Objective: This Case Study describes the experience of Rovira i Virgili University School of Medicine (URV) with the early introduction of pre-clinical skills learning in the undergraduate medical curricula to monitor and assessing these competencies as a prerequisite for medical students accessing their training in clinical settings. Course Development: A PRE-CLINICAL SKILLS course has been developed to guarantee medical student's performance in managing clinically relevant basic medical sciences to interpret clinical scenarios, to develop technical communication skills and to value professional behavior throughout the first two years of medical education. The set of pre-clinical competencies evaluated in this course as well as the corresponding assessment methods have been established according to an international reference standards review work in collaboration with the regional quality assurance agency. An integrated formative assessment is being used. Course Advantages, Added Values and Outcome Measures: Since the academic year 2009-2010 about 130 students from second-year of Medicine follows this integrated trunk-course while being enrolled in parallel in other core courses as Physiology, Anatomy, and Histology. The program doesn't include lectures but only learning activities to train and monitor the successful achievement of the pre-clinical skills by medical students. A good majority of the participants achieve readiness for start training in clinical settings. As a whole, this course is useful ensuring patient's safety by identifying weaknesses acquisition of pre-clinical skills and predicting medical students who will have difficulty during their clinical training. Conclusions: Reflecting on our experience, we believe that the named course "PRE-CLINICAL SKILLS" overcomes the disadvantages of the traditional teaching methods. Helping students to conceptualize rather than memorize and encouraging them to integrate clinically relevant basic medical sciences concepts and principles by training pre-clinical skills in this competence-based assessment course prior entering into clinical settings., (Copyright: © 2017 Fenoll-Brunet MR et al.)

The fracture of the medial orbital wall is relatively common in orbital trauma. Titanium mesh is possibly the actual standard material for orbital wall reconstruction. When the floor of the orbit and the medial wall are simultaneously affected, one larger mesh gives better results than two independent meshes that need to be fixated independently. However, large meshes need a wider surgical field. To gain sufficient exposure to the medial and inferior orbital walls simultaneously, we present an approach that combines the transconjunctival and transcaruncular incisions, detaching if needed the inferior oblique muscle and, placing our mesh, repositioning it beside the lacrimal duct. This technique should not entirely displace traditional approaches, but it widens the surgical exposure for middle- and upper-third facial trauma. This alternative has minimum morbidity and can save a great deal of surgery time.

Introduction: The iliac crest flap is commonly used in reconstructions of the head and neck. The vascularisation of this region depends on the deep circumflex iliac artery and vein (ACIP/VCIP). The present study describes for the first time, the simultaneous use of the deep and superficial circumflex iliac systems to obtain an iliac crest flap for head and neck reconstructions., Material and Method: Ten inguinal regions were dissected in five cadavers in the Human Anatomy and Embryology Unit of the Faculty of Medicine of the Rovira i Virgili University. In the period 2005-2007, three patients required mandibular reconstruction with a microvascularised iliac crest osteocutaneous flap at the Maxillofacial Surgery Unit of the Joan XXIII University Hospital., Results: The 3 cases showed a favourable outcome. This "supercharging" variation guarantees the perfusion to the skin flap, provides a better three-dimensional arrangement of the soft tissue and lowers the morbidity at the donor site, as much less internal oblique muscle cuff is harvested., Conclusions: This technique may be of great interest in the reconstruction of complex maxillofacial defects instead of having to carry out a vascular dissection and its extra anastomosis.

To assess coagulation activation and endothelial cell injury in normotensive and pre-eclamptic pregnant women, a comparison was made of plasma levels of tissue factor, fibronectin, fibrinopeptide A and D-dimer. Samples were taken from 50 nonpregnant women, 40 normotensive pregnant women in the third trimester and 27 women with pre-eclampsia after diagnosis and before treatment. High levels of fibrinopeptide A and D-dimer were found in pre-eclamptic women. Moreover, the ratio fibrinopeptide A:D-dimer was much greater in the pre-eclampsia group than in normotensive pregnant women. The levels of fibronectin and tissue factor were also higher in the pre-eclampsia group. The increase of tissue factor levels suggests an alteration of the extrinsic coagulation pathway in pre-eclampsia. The increase of fibrinopeptide A:D-dimer ratio shows that the activation of coagulation is associated with a relative hypofibrinolysis in pre-eclampsia.

Pineal cell aggregates in 5, 10 and 15 day-old chick embryos have been studied. Cell aggregates were classified into rosettes or vesicles and spheroid and ellipsoid vesicles distinguished. The number of pineal vesicles per unit of surface (vesicle density) was determined in three pineal portions: apical, anterior and posterior. By day 5, only cellular rosettes were found, mainly in the apical portion. After 10 and 15 days, the presence of rosettes was occasional. The posterior wall showed only small spheroid vesicles, while in the apical and anterior areas ellipsoid vesicles were also observed. Moreover, the spheroid/ellipsoid vesicle ratio increased from the 10th to the 15th day of incubation. The vesicle density decreased between the 10th and 15th day because of the increase in both vesicle and pineal size, without changes in the total number of vesicles. The results suggest that changes in vesicle morphology and density could be related to the functional activity of the pineal gland during embryonic development.

The effects of static electromagnetic fields on the development of the chick embryo pineal gland were studied. A total of 144 fertilized White Leghorn eggs were sacrificed after 5, 10 and 15 days of incubation. The stage of development was determined in all embryos using the Hamburger and Hamilton method [J Morphol 49: 88-92, 1951]. The various morphometric parameters (diameter and distance of the pineal gland and its lumen) were measured on serial 7-micron-thick sections. The data were obtained in a morphometer and processed statistically. The intensities of the static electromagnetic fields were 18 and 36 mT. Control and exposed embryos were equally distributed and randomly assigned. After 5 days of incubation, 25% of embryos exposed to a static electromagnetic field of 18 mT had a more advanced stage of development than controls and embryos exposed to 36 mT. On the 10th and 15th day, embryos exposed to either 18 or 36 mT tended to be more developed than controls. In the morphometric study, results were similar for the controls and exposed embryos after 5 and 10 days of incubation. However, the values of the 15-day-old embryos exposed to static magnetic fields were lower than the values of the controls (p > 0.01). These differences were more pronounced in the embryos exposed to 36 mT. These results seem to indicate that static electromagnetic fields affect the development and growth of embryos unequally, and that their action can depend not only on the intensity of the static electromagnetic field, but also on the length of exposure and the organ which is developing. It may be interesting to use these data in ultrastructural and physiological studies.

Morphofunctional study of umbilical cords from pregnancies complicated by preeclampsia shows both activation and lesion of endothelium. The cellular findings in umbilical cords from pregnancies complicated by preeclampsia can be summarized as: (i) higher number of cells with secretion bladders and increase in the number and size of both secretion bladders and microvilli-like protrusions; (ii) increase in collagen, fibrin, fibronectin and lipidic vesicles in the vessel wall; (iii) vacuolization of endothelial cells; (iv) presence of lipidic vacuoles and lipophages in the vessel wall; (v) erosion and disorganisation of the endothelium that exposes extracellular proteins to the blood flow. Endothelial cell cultures from preeclamptic pregnancies show kinetic disorders and cell detachment. The results confirm that an endothelial cell lesion occurs in preeclampsia and this cellular disorder can be reproduced in vitro.

Few studies have been performed to evaluate the ultrastructural changes that exposure to static magnetic fields (SMF) can cause to the processes of cell migration and differentiation in the cerebellum during development. Thus, we have studied the development of the cerebellum in the chick embryo (n = 144) under a uniform SMF (20 mT). All of our observations were done on folium VIc of Larsell's classification. The cerebella of chick embryos, which were exposed solely on day 6 of incubation and sacrificed at day 13 of incubation [short exposure (S)1; n = 24], showed an external granular layer (EGL) that was less dense than the EGL in the control group (n = 24). The molecular layer (ML) exhibited a low number of migratory neuroblastic elements. Moreover, the internal granular layer (IGL) was immature, with the cellular elements less abundant and more dispersed than in controls. In chick embryos exposed on day 6 of incubation and sacrificed at day 17 (S2; n = 24), the outstanding feature was the regeneration of the different layers of the cerebellar cortex. The cerebellar cortex of chick embryos exposed continuously to an identical field from the beginning of the incubation up to day 13 [long exposure (L)1; n = 24] or day 17 (L2; n = 24) of incubation showed a higher number of alterations than that of group S1. Electron microscopy confirmed the findings from light microscopy and, at the same time, showed clear signs of cell degeneration and delay in the process of neuronal differentiation. This was more apparent in groups L1 (100%) and L2 (100%) than in groups S1 (95.4%) and S2 (65.2%). In conclusion, the present study showed that SMF can induce irreversible developmental effects on the processes of cell migration and differentiation of the chick cerebellar cortex.

The influence of continuous electromagnetic fields (0, 181 or 361 Gs/cm2) on the development of chick embryo (n = 144) was studied. Several parameters were determined at days 5, 10 and 15 of incubation: stage (following Hamburger and Hamilton), vertex-coccyx length (size) and weight. At 5 days of incubation, all embryos showed a similar stage. However, at days 10 and 15, the embryos exposed to 181 Gs/cm2 showed a stage significantly superior to that of the others. There were no differences between the exposed embryos and the control ones with regard to weight and stature, except at 15 days when the embryos exposed to 361 Gs/cm2 showed greater weight and stature than those of the controls.

A silver impregnation method and a morphometric approach were used to define differences existing in the motor nerve terminal branching pattern between a fast-twitch muscle (extensor digitorum longus) and a slow-twitch one (soleus) of the normal adult rat. Because no single measure can describe precisely all geometrical properties (ie both topology and metrics) of the nerve terminals, we evaluated morphologic parameters defining length and angular characteristics in the different terminal segments classified according to their centrifugal order. The main results indicate that the distal free-end segments in the extensor digitorum longus muscle are shorter and less divergent than in the soleus nerve terminals. The endings in the two muscles have different fractal dimensions. Findings are discussed in the context of the hypothetical mechanisms governing motor nerve terminal size and complexity.

meso-2,3-Dimercaptosuccinic acid (DMSA), an antidote for the treatment of experimental and human poisoning by a number of heavy metals, has been reported to reduce the lethality of animals poisoned with arsenic more effectively than 2,3-dimercaptopropanol. In the present study, the effect of DMSA on arsenite-induced embryotoxic and teratogenic effects was evaluated in mice. In a first experiment, a series of four DMSA injections was administered sc to pregnant Swiss mice immediately after a single ip injection of 12 mg/kg of sodium arsenite (NaAsO2) given on Day 10 of gestation, and at 24, 48, and 72 hr thereafter. DMSA effectiveness was assessed at dosage levels of 0, 80, 160, and 320 mg/kg/day. Treatment with DMSA significantly reduced the embryolethality and the incidence of gross external and skeletal malformations and variations provoked by NaAsO2. Based on these findings, the effect of increasing the time interval between acute arsenite exposure and initiation of DMSA therapy was investigated in a second experiment. On Day 10 of gestation, DMSA (320 mg/kg) was administered sc to pregnant mice at 0, 0.25, 0.50, 1, 4, or 12 hr after a 12-mg/kg ip dose of NaAsO2. Embryotoxicity and teratogenicity derived from NaAsO2 exposure were significantly reduced when DMSA was given during the first hour after NaAsO2 injection. According to these results, a delay between acute arsenite intoxication and DMSA treatment should be avoided to have a practical beneficial effect on the arsenite exposed conceptus.

In a series of 215 anteroposterior X-ray films, a study was made of the horizontal distance between the pedicles of each lumbar vertebra, first of all sequentially, describing the morphology adopted by the lateral limits of the canal, and secondly determining the absolute value for each level separately and in relation to the variables of sex and age. The absolute value of this distance at each level is related to the thickness of the pedicles and the width of the vertebral bodies of L3 and L4. The values obtained were tested with the appropriate statistics in each case.